P - 78320�
REQUEST FOR ELECTRICAL INSPECTION
1. - 3�� 3 8 9 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529 �
www. electricity. state. mn. us
Identify the work red by this request:
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR b
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transfortners u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner I Power Su for Si ns / Outline Li htin �$5
/ 0 to 200 Am re �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri s�$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20) 15�
Each Addilional Unit � $25 `°�""�"°A �E °"`r %
OTHER ADDITIONAL FEES � � ,�: � J �--� - �'I
Li hdn Retrotit �$25 r Fi�ure
CeMer Pivot Irri ation Boom �$40
Manufaclufed Home Park Lots �$25 I hereb ce' that I inspected the electrical installa6on described herein on the dates stated:
Recreational Vehicle Park Sites � f01f*'" �/� �'�'/
S rate Bondin Ins ion � y `�"%
S �al In 'on � $30 r Hour � ""` "'�"0" .�' � `�-j �
S ial In ' n�$.31 r Mile /
THIS INSTALLATION MAY BE ORDERED DISCONNECTE T COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY �) OQ
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Fieq/uest Date: Rough-in InspecKion Required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Call
Gi/9�� You must call the inspector when ready! Date Ready:
I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspecction of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
v��1 �/CB �P�it �t, v0 �/�l�L- l� j/ � /V ���� �
S 6an Township Range Fire No. County
30 d�Y i!//i /I/r/ /i�
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Power Supplier Address
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Electrical Contractor / Company Name Contractor License Number Master License Number
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Mailing Address (Contrador, Company or Owner Perfortning Installalion)
S .
Autho ' tra r, Com y r Owner ertorming Installation) Phone ��� �
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EB•00001A-13 7/1/2000 BOARD OF ELECTRICRV COPY INSTRUCTIONS ON BACK OF YELLOW COPY